TABLE 1.

Cognitive Orthotics, Environmental and Advanced Integrated Sensors With Potential Applications to Dementia Care

Cognitive, Functional, or Physiological Deficit	Product Name	Description and Approach	Level of Maturity	Target Population	Clinical Studies with Dementia Subjects	Pros and Cons
Cognitive–prospective memory aid	Memory Glasses13	A wearable context-aware memory aid and reminder system, in the form of eyeglasses, which may also be effective in managing anomia and certain forms of agnosias	Research prototype	Normal aging, amnesia, MCI, mild AD or other dementia, prosopagnosia	No	Prototype evaluations have been conducted, but only with healthy users
Cognitive–prospective memory aid	MemoClip14	A memory aid in the form of a badge that is clipped to clothing that associates task information with time, location and context	Research prototype	Normal aging, amnesia, mild AD, or other dementia	No	Prototype evaluations have been conducted, but only with healthy users
Cognitive–prospective memory aid	Friedman1	A prospective memory aid consisting of a wearable microcomputer using radio and ultrasound to communicate with the user's environment. It determines the user's location and provides task-related information	Research prototype	Normal aging, MCI, mild AD, or other dementia	No	Prototype evaluations have been conducted, but only with healthy users. It provides voice prompts only as needed, thus decreasing the user's dependence on the system
Cognitive–prospective memory aid	PEAT (Planning and Execution Assistant and Trainer)16	An automatic planning software that is customizable for individual perceptual and cognitive deficits. The system operates on a PDA (personal digital assistant) or mobile phone, and provides personalized cueing to guide the user through multi-step procedures and ADLs using digital pictures and voice recordings. It is flexible (tasks and times) and adaptive	Commercial product	As above	No	PEAT is available in preconfigured or non-configured versions, and can be customized to particular human needs and output devices
Cognitive–prospective memory aid	ISAAC17	A wearable fully individualized cognitive aid that organizes and delivers individualized prompts, procedural and personal information. It delivers prompts in synthesized speech audio, text, checklists, or graphic format	Commercial product	Normal aging, MCI, mild AD or other dementia, anoxic or traumatic brain injury	No (only case studies of users with anoxic or traumatic brain injury have been published)	ISAAC is easily adaptable, and suitable for individuals with poor vision or hearing impairment. The device requires user training however that may be difficult for some persons with cognitive impairment
Cognitive–prospective memory aid	AutoMinder18	A cognitive orthotic capable of modeling a subject's daily plans, tracking their execution, and determining whether and when to provide reminder(s)	Research prototype	Normal aging, MCI, mild to moderate AD, or other dementia	No	AutoMinder is an early prototype that remains to be evaluated with its stated target population
Cognitive–aphasia	VERA (Visually Enhanced Recipe Application)19	An interface using text and sound options that allow primarily visual cooking instructions to be individually customized for aphasic users	Research prototype	Normal aging, aphasia	No	It is not clear whether one interface modality (text or sound) is superior to the other for providing cooking reminders
Cognitive–aphasia	Cook's Collage20	A video-based reminder system that guides a user through a multistep cooking task by displaying the previous six steps taken on a monitor	Research prototype	Normal aging, aphasia	No	A longitudinal study with an anticipated sample of size of 20 participants (10 older, 10 younger) is currently in progress
Cognitive–navigational tool	IMP (Intelligent Mobility Platform)21 Indoor navigation system	A walker-based device designed to navigate lost or confused users. It uses a laser beam range-finder, a handheld computer with a touchscreen interface, and navigation software	Research protoytpe	Normal aging, MCI, mild to moderate AD or other dementia	No	IMP is only suitable for persons who require an ambulatory device such as a walker
Cognitive–navigational tool	Opportunity Knocks22 Navigation system for outdoors	A cell phone embedded device using GPS chip and Bluetooth that learns the subject's standard routes in the community, and alerts the subject of a navigational error by making a knocking sound and re-routes the lost individual	Research prototype	As above	No	The device may need substantial training before it effectively knows a user's route
Cognitive–navigational tool	Activity Compass23	A Palm pilot-based GPS system that learns a subject's routine travel behavior in order to predict likely destinations, and re-routing a lost individual	Research prototype	As above	No	Activity Compass incorporates explicit feedback from the user in terms of what aspects of the route are followed or ignored. The system however is large and bulky as a handheld device
Environmental24	Motion detector	Senses movement and posture, and uses ultrasound to sense distance	Commercial product			Effective in combination with other environmental sensors to track activity patterns and deviations from personal norms
Environmental	Light sensor	Detects light	Commercial product			As above
Environmental	Temperature/heat sensor	Detects and calibrates temperature	Commercial product			As above
Environmental	Force sensor	Monitors rapid change in pressure	Commercial product			As above
Environmental	Pressure sensor	Monitors presence or absence of pressure	Commercial product			As above
Environmental	Contact sensor	Registers contact with doors, appliances, furniture	Commercial product			As above
Environmental	Video camera	Records moving image and sound	Commercial product			As above
Environmental	Proximity detector	Senses proximity	Commercial product			As above
Environmental	Door and window sensor	Senses whether a door or window has been opened	Commercial product			As above
Environmental	Leak and spill detector	Detects presence of liquid spills	Commercial product			As above
Environmental	Glass break detectors	Detects if glass has been shattered	Commercial product			As above
Environmental	Vibration/sound detectors	Detects vibration against a surface	Commercial product			As above
Environmental	Electrical usage sensors	Detects usage of electricity and change in pattern	Commercial product			As above
Environmental	Water/sewer usage sensor	Detects flow through pipes and change in pattern of flow	Commercial product			As above
Environmental	Voice activation sensors	Voice commands that permit interactions with doors, security systems, lights, blinds, appliances	Commercial product			As above
Physiological/functional	Bedwetting alarms25	Pad monitors the presence of moisture	Commercial product	Any persons with bedwetting, irrespective of cognitive impairment		Multiple different types of bedwetting alarms are commercially available
Physiological/functional	GlucoMON26	Real-time monitoring of blood glucose	Commercial product	Any person whose blood glucose levels need to be closely monitored		GlucoMon works with existing blood glucose meters
Physiological/functional	VTT gait monitor27	Monitors gait and recognizes changes in gait pattern	Research prototype	MCI, mild to moderate AD, or other dementia	No	The device will require substantial training to effectively recognize deviations from baseline gait patterns
Physiological/functional	Displacement sensor28	Monitors gait	Research prototype	As above	No	As above
Physiological/functional	Accelerometers29	Track and record one, two, and three-dimensional motion	Commercial product	As above	No	Effective in combination with other environmental sensors to track activity patterns and deviations from personal norms
Physiological/functional	Fall detector30	An impact and posture/orientation detector that works in conjunction with existing home alarm systems	Commercial product	As above	No	As above
Physiological/functional	SIMBAD Project (Smart Inactivity Monitor Using Array-Based Detectors)31	A wall-mounted inactivity and fall detector consisting of low-cost, array-based passive infrared sensors	Research prototype	As above	No	SIMBAD does not require the subject to wear or activate the device. It accurately detected falls in only 35.7% of controlled laboratory tests
Physiological/functional	University of Virginia floor vibration-based fall detector32	A piezoelectric sensor coupled to the floor surface to evaluate the floor's vibration patterns	Research prototype	As above	No	Falls were simulated using anthropomorphic dummies, and demonstrated 100% true positives and 0% false alarms. The system does not require the subject to wear or activate the device
Physiological/functional	Fall detector33	A fall detection system that is based on computer processing of images collected via a ceiling-mounted digital camera	Research prototype	As above	No
Physiological/functional	Vibrating gel insoles34	Viscoelastic silicone gel insoles that are embedded with vibrating elements to improve balance	Research prototype	As above	Yes; 15 young (mean age 23 ± 2 years) and 12 older (mean: age 73 ± 3 years) participated in a clinical trial; all 8 sway parameters improved in older users	The lightweight sensor is easy to embed in shoes
Advanced integrated sensor set	BodyMedia35	A wearable device in the form of an upper arm band that collects metabolic and physiological information (calories, steps taken, sleep and wake cycle)	Commercial product	Any individual who requires monitoring of metabolic and physiological parameters	No	The armband may feel uncomfortable or intrusive for some older users
Advanced integrated sensor set	WearNET36	A multi-sensor activity and context monitoring system	Research prototype	MCI, mild to moderate AD or other dementia	No
Advanced integrated sensor set	SenSay (Sensing and Saying)37	A multi-sensor activity and context monitoring system in the form of a wrist-worn device	Research prototype	As above	No	The wrist device is large, and some training time may be needed to implement the system with new users
Advanced integrated sensor set	Multi-accelerometer based systems38	A system designed to monitor activity and context	Research prototype	As above	No
Advanced integrated sensor set	Garmin Forerunner39	A wrist worn GPS and monitor that tracks heart rate, speed, distance, and calories burned	Commercial product	Any person requiring monitoring of metabolic or physiological parameters	No	The Garmin Forerunner was developed primarily for athletes. The data may not provide sufficient granularity for some research applications
Advanced integrated sensor set	Medical mood ring40	A wearable device in the form of a ring that monitors temperature, heart rate, and blood oxygen level. It contains a wireless link that can transmit vital signs to a cell phone or computer to allow a caregiver to determine remotely whether a person needs assistance	Research prototype	As above	No
Advanced integrated sensor set	Tadiran's MDkeeper41	A device that monitors pulse, 1-lead EKG and blood oxygen level. The data are transmitted, either in real-time or periodically, to a remote medical center for further analysis and care	Commercial product	As above	No	The proprietary software is pre-programmed and cannot be modified
Advanced integrated sensor set	Ciclosport Alpin 542	A device that monitors heart rate with altimeter functions	Commercial product	As above	No	The device was developed for athletes, and the data may not provide sufficient granularity for some research applications
Advanced integrated sensor set	Boardbug43	A wrist worn device that monitors behavior through sound, temperature, location	Commercial product	Any person whose activities need to be monitored irrespective of cognitive impairment	No
Advanced integrated sensor set	CareWatch44	A multi-sensor caregiver alarm system that detects whether a cognitively impaired person is in bed, moving within the house, or opening a door	Research prototype	MCI, mild to moderate AD or other dementia	Yes	Published data are available from a clinical trial with dementia users
Advanced integrated sensor set	CareMedia45	An automated video and sensor analysis system that monitors activity, behaviors, and social interactions continuously in real-time	Research prototype	Mild to severe AD or other dementia	Yes	A feasibility study and a follow-up comprehensive study have been conducted on a locked dementia unit
Advanced integrated sensor set	COACH (Cognitive Orthosis for Assisting Activities in the Home)46	A computer vision based system that associates hand positions with specific handwashing steps to provide cueing strategies	Research prototype	MCI, mild to moderate AD or other dementia	Yes	10 Moderately to severely demented users performed 25% more steps correctly without the assistance of a caregiver
Advanced integrated sensor set	Radiofrequency (RF) transmitter based home monitoring system47	The home of a person at risk for dementia is instrumented with various motion detection devices, and a small wireless network consisting of 3 RF receivers. The person at risk for dementia and his/her family caregiver must wear an RF transmitting wrist watch to monitor the at risk person's motion within the home	Research prototype	Persons at risk for dementia	No	The feasibility of the research prototype has only been demonstrated in a single home using a 3-week longitudinal record of RF transmission data as part of a larger study of persons at risk for dementia
Advanced integrated sensor set	PROACT (Proactive Activity Toolkit)48	PROACT is a computer based approach involving the use of RF technology that attempts to automatically recognize and record ADLs and the quality of their performance. The user of this system must wear a prototype glove that is capable of detecting and recording RF signals from RF tags that are unobtrusively placed on objects. Data collected by the glove are then analyzed to infer the ADLs that are executed	Research prototype	MCI, mild to moderate AD or other dementia	No	14 subjects (age range 25 to 63 years; mean 39) performed 14 ADLs over a 6 week period in a research home. PROACT correctly detected that an ADL occurred 88% of the time. Of these, it correctly recognized the specific ADL activity in 73% of cases
Advanced integrated sensor set	Sensvest49	An intelligent garment that monitors heart rate, temperature, movement	Research prototype	Any person whose physiological parameters need to be monitored	No
Advanced integrated sensor set	VTAM T-shirt (Vetement de Tele-Assistance Medicale)50	A Biosensor and bioactuator based garment that monitors EKG, respiratory rate and temperature, and also detect a fall	Research prototype	As above	No	A prototype system has been tested with only 3 users whose demographic and clinical characteristics were not reported
Advanced integrated sensor set	European Commission SmartFabrics Project (WEALTHY garment, MyHeart, MERMOTH, OFSETH)51a	An intelligent garment in the form of a vest that monitors EKG, respiration, EMG, and physical activity	Research prototype	As above	No	Potential users may not wish to wear a comprehensive garment. Wealthy garment has been tested with 5 cardiac and 7 healthy adult users (no subject over age 64 years)
Advanced integrated sensor set	MagIC vest (Maglietta Interattiva Computerizzata)52	An intelligent garment that monitors EKG, respiratory frequency, and assesses motion	Research prototype	As above	No	A prototype system has been tested with 9 healthy and 14 cardiac inpatient users (no further description of the demographic or clinical characteristics of the cohort reported)
Advanced integrated sensor set	SmartShirt garment53	An intelligent garment that monitors heart rate, EKG, respiration, temperature, and a host of other vital functions	Research prototype	As above	No	The garment has been launched for field trials in 2006
Advanced integrated sensor set	LifeShirt54	An intelligent garment that measures respiration, posture, and activity	Research prototype	As above	No
Advanced integrated sensor set	Intel Multisensor board55	A pedometer, accelerometer, and GPS sensor combined into a mobile package worn on the belt	Research protoytype	Any person whose activities need to be monitored.	No	The device may be too bulky for some users, and additional software will need to be developed to make data useful
Advanced integrated sensor set	Microsoft Sensecam56	A neck worn sensor package, including a digital camera that takes images passively, without user intervention, and sensors that note change in light, body heat, and a three axis accelerometer	Research prototype	As above	No	Low resolution images may not be sufficient for memory support. Case reports with older persons with limbic encephalitis and mild to moderate AD suggest improved recall of autobiographical events

^aFull names for the acronyms not provided by the system developers.

AD: Alzheimer disease; ADLs: activities of daily living; GPS: Global Position Sensor; MCI: Mild Cognitive Impairment; RF: radiofrequency.